Perinatal Diagnostic Center Ultrasound & Genetic Counseling Order Form

 

* Select a PDC Office Location:

 

* Required

While we strive to accommodate your preferred PDC location choice, there may be instances where scheduling at an alternate PDC location becomes necessary due to availability. Our commitment is always to provide the best service possible, and this flexibility allows us to do so.

Required Patient Information

Ultrasounds & Procedures
Antepartum Testing

(NST only done in Palo Alto)

Consults
Indications (Required) – Check all that apply

 

* Check the following for this pregnancy:

Referring Provider
Insurance Information
Document Upload

Please attach the following documents:

  • All relevant clinical documents (i.e. clinic notes, history and progress notes, medication history, growth charts-height and weight, head circumference, labs, diagnostic reports and a copy of the insurance card)
  • Facesheet with demographics
  • A copy of insurance card
  • All prenatal records (if referring to the Modesto, Salinas, or Santa Cruz practices)

Upload File (up to 30 files):


Attached Files
    Directions & Maps
    Perinatal Diagnostic Center – Palo Alto
    Perinatal Diagnostic Center – Palo Alto

    725 Welch Road

    Suite 391

    Palo Alto, CA 94304

    Maps, Directions & Parking

    3rd Floor

    See a detailed map and guide to our clinics in English (PDF).

    Genetic Counseling: (650) 723-5198

    Phone: (855) 485-3357

    Fax: (650) 725-9877

    Open 8 a.m. to 5 p.m.
    • Mon: 8 a.m. - 5 p.m.
    • Tue: 8 a.m. - 5 p.m.
    • Wed: 8 a.m. - 5 p.m.
    • Thu: 8 a.m. - 5 p.m.
    • Fri: 8 a.m. - 5 p.m.
    • Sat: Closed
    • Sun: Closed
    Perinatal Diagnostic Center – Redwood City
    Perinatal Diagnostic Center – Redwood City

    2900 Whipple Avenue

    Redwood City, CA 94062

    Maps, Directions & Parking

    Suite 240

    See a detailed map and guide to our clinics in English (PDF).

    Phone: (650) 381-3480

    Fax: (650) 381-3488

    Open 8 a.m. to 5 p.m.
    • Mon: 8 a.m. - 5 p.m.
    • Tue: 8 a.m. - 5 p.m.
    • Wed: 8 a.m. - 5 p.m.
    • Thu: Closed
    • Fri: 8 a.m. - 5 p.m.
    • Sat: Closed
    • Sun: Closed
    Perinatal Diagnostic Center – Fremont
    Perinatal Diagnostic Center – Fremont

    2147 Mowry Avenue

    Fremont, CA 94538

    Maps, Directions & Parking

    Suite C6

    See a detailed map and guide to our clinics in English (PDF).

    Note:

    Tues: closed for patient care, administrative services only

    Phone: (510) 713-9994

    Fax: (510) 713-9997

    Open 8 a.m. to 5 p.m.
    • Mon: 8 a.m. - 5 p.m.
    • Tue: Closed
    • Wed: 8 a.m. - 5 p.m.
    • Thu: 8 a.m. - 5 p.m.
    • Fri: 8 a.m. - 5 p.m.
    • Sat: Closed
    • Sun: Closed
    Perinatal Diagnostic Center – Salinas
    Perinatal Diagnostic Center – Salinas

    212 San Jose Street

    Salinas, CA 93901

    Maps, Directions & Parking

    Suite 311

    See a detailed map and guide to our clinics in English (PDF).

    Phone: (831) 440-3441

    Fax: (831) 440-3432

    Open 8 a.m. to 5 p.m.
    • Mon: 8 a.m. - 5 p.m.
    • Tue: 8 a.m. - 5 p.m.
    • Wed: 8 a.m. - 5 p.m.
    • Thu: 8 a.m. - 5 p.m.
    • Fri: 8 a.m. - 5 p.m.
    • Sat: Closed
    • Sun: Closed
    Perinatal Diagnostic Center – Santa Cruz
    Perinatal Diagnostic Center – Santa Cruz

    1685 Commercial Way

    Ste A

    Santa Cruz, CA 95065

    Maps, Directions & Parking

    See a detailed map and guide to our clinics in English (PDF).

    Phone: (831) 464-9994

    Fax: (831) 464-9996

    Open 8 a.m. to 5 p.m.
    • Mon: 8 a.m. - 5 p.m.
    • Tue: 8 a.m. - 5 p.m.
    • Wed: 8 a.m. - 5 p.m.
    • Thu: 8 a.m. - 5 p.m.
    • Fri: 8 a.m. - 5 p.m.
    • Sat: Closed
    • Sun: Closed
    Perinatal Diagnostic Center – Modesto
    Perinatal Diagnostic Center – Modesto

    200 E Granger Ave

    Modesto, CA 95350

    Maps, Directions & Parking

    See a detailed map and guide to our clinics in English (PDF).

    Phone: (209) 672-6377

    Fax: (209) 672-6378

    Open 8 a.m. to 5 p.m.
    • Mon: 8 a.m. - 5 p.m.
    • Tue: 8 a.m. - 5 p.m.
    • Wed: 8 a.m. - 5 p.m.
    • Thu: 8 a.m. - 5 p.m.
    • Fri: 8 a.m. - 5 p.m.
    • Sat: Closed
    • Sun: Closed